Nursing home-acquired pneumonia: an emergency department treatment algorithm

SUMMARY

Nursing home-acquired pneumonia (NHAP) is a leading cause of morbidity, hospitalization, and mortality among older nursing home residents. Too often, these patients are erroneously grouped with cases of community-acquired and hospital-acquired pneumonia. Yet, they differ in terms of most common pathogens, significant underlying disease, impaired functional and cognitive status, and poor nutrition. The NHAP emergency department treatment algorithm presented here shows that an important decision for initial care in the emergency department (ED) is whether the patient should return to the nursing home. This decision often is based on the facility's ability to administer parenteral antibiotics, and care for co-morbidities and complications. Cephalosporins are the foundation of initial treatment of NHAP in the ED, and are combined with other antibiotics in anticipation of the most likely pathogens and treatment variables discussed here. It is hoped the NHAP treatment algorithm will contribute to improved outcomes.     

卡前列素氨丁三醇治疗产后出血临床疗效观察

目的:探讨卡前列素氨丁三醇在预防和治疗产后出血过程中的应用。方法:胎儿分娩后静脉注射宫缩素10IU,同时肌肉注射10IU。产后出血追加宫缩素20IU或联合米索前列醇300μg进行舌下含服,子宫收缩仍然不好时,肌肉注射卡前列素氨丁三醇250μg。结果:配合使用卡前列素氨丁三醇的试验组总有效率为93.3%,未使用卡前列素氨丁三醇的对照组总有效率仅为60.0%。结论:大多数具有产后出血倾向因素的剖宫产患者,使用宫缩素的同时给予卡前列素氨丁三醇,可以很好地预防和治疗产后出血状况,效果明显且快速、安全,值得临床推广应用。     

Microbial Keratitis in East Africa: Why are the Outcomes so Poor?

Purpose: Microbial keratitis (MK) is a major cause of blindness in Africa. This study reports the epidemiology, causative organism, management and outcome of MK in people admitted to a large referral hospital in Northern Tanzania, and explores why the outcomes are so poor for this condition.

Methods: A retrospective review of all admissions for MK during a 27-month period. Information was collected on: demographics, history, examination, microbiology, treatment and outcome.

Results: A total of 170 patients with MK were identified. Presentation was often delayed (median 14 days), and more delayed if another health facility was visited first (median 21 days). Appropriate intensive antibiotic treatment was prescribed in 19% before admission. Lesions were often severe (41% >5mm). Filamentary fungi were detected in 25% of all specimens (51% of specimens with a positive result). At discharge, 66% of affected eyes had a visual acuity of less than 6/60. Perforations developed in 30% and evisceration was necessary in 8%. Perforation was associated with large lesions and visiting another health facility. HIV infection was diagnosed in 16% of individuals tested, which is approximately twice the prevalence found in the wider population.

Conclusions: Microbial keratitis is a significant clinical problem in this region, which generally has a very poor outcome. Delayed presentation is a critical issue. Fungal keratitis is a prominent cause and there is an indication that HIV may increase susceptibility. Prompt recognition and appropriate treatment in primary/secondary health facilities and rapid referral when needed may reduce the burden of blindness from this disease.     

整体护理在治疗上消化道大出血中的应用效果研究

目的分析整体护理在治疗上消化道大出血中的应用效果。方法随机选取110例上消化道大出血患者,分为观察组和对照组。治疗的同时分别采用整体护理和常规方式进行护理,对比两组整体治疗情况。结果两组疗效比较差异有统计学意义（P〈0.05）。结论整体护理在治疗上消化道大出血中的应用效果明显,值得临床推广。     

左半结肠癌并梗阻Ⅰ期手术切除吻合的治疗体会

目的：探讨左半结肠癌并梗阻Ⅰ期手术切除吻合的治疗方法及围术期处理原则。方法：回顾性分析2005年5月～2010年5月Ⅰ期手术切除吻合左半结肠癌并梗阻患者20例的临床资料。结果：术后19例痊愈出院,无吻合口瘘,其中包括3例并发切口感染;1例放弃治疗,自动出院。结论：左半结肠癌并梗阻Ⅰ期手术切除吻合是比较安全可靠的治疗方法,但是也要严格掌握适应证,术中肠管闭式减压和结肠灌洗、围术期营养支持、高效广谱抗生素的应用、手术技术提高等是预防吻合口瘘的关键。     

长春西汀联合泼尼松治疗原发性肾病综合征疗效观察

目的观察长春西汀联合泼尼松治疗原发性肾病综合征的临床疗效。方法选取原发性肾病综合征患者62例，随机分为观察组和对照组。对照组采用泼尼松及常规治疗，观察组在对照组治疗基础上给予长春西汀注射液静脉滴注，两组疗程均为3周。观察两组患者临床改善情况。结果观察组总有效率（83．9％）明显高于对照组总有效率（61．3％）（P〈0．05），两组治疗后血浆白蛋白、24h尿蛋白定量与本组治疗前比较有统计学差异（P〈0．05），观察组较对照组改善更显著（P〈0．05），观察组尿素氮、血肌酐、活化部分凝血活酶时间、纤维蛋白原、D-二聚体较治疗前明显改善（P〈0．05），与对照组相比有统计学差异（P〈0．05）。结论长春西汀联合泼尼松治疗原发性肾病综合征安全有效，能有效改善血液高凝状态。     

昆明地区巴贝西虫病一例分析

该文报道了在昆明地区发现的一例人巴贝西原虫病例的诊断与治疗过程.依据光镜和透射电镜形态学观察,初步判断该病例系巴贝西虫感染,并使用抗原虫、抗感染联合治疗获得了良效.     

斑秃治疗进展

斑秃是一种皮肤科常见的良性、以非瘢痕性脱发为主要表现的疾病,严重影响美观.传统的治疗方法基于局部或系统应用糖皮质激素或米诺地尔等促毛发生长药物.随着对斑秃发病机制研究的不断深入,出现了一些新的尝试性的治疗方法,如免疫调节剂、新型生物制剂、308 nm准分子激光、PUVA 等,由于这些疗法缺乏大规模随机对照试验的证据支持并存在较多不良反应,因此在临床上的应用受到限制,但为以后开发新型治疗药物提供了有益的思路.今后斑秃治疗研究的热点将是针对发病机制的靶向治疗并最大限度减少不良反应.